scholarly journals Atypical femur fractures: current understanding and approach to management

2020 ◽  
Vol 12 ◽  
pp. 1759720X2091698
Author(s):  
Lianne Tile ◽  
Angela M. Cheung
Keyword(s):  
Medical Therapy ◽  
Clinical Decision Making ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Clinical Decision ◽  
Current Understanding ◽  
Rare Type ◽  
Femur Fractures ◽  
Atypical Femur Fractures

Osteoporosis and resulting osteoporotic fractures are responsible for significant morbidity, excess mortality, and health care costs in the developed world. Medical therapy for osteoporosis has been shown in multiple randomized controlled trials to reduce the risk of vertebral and non-vertebral fractures and hip fractures, and in some studies bisphosphonate medications have been associated with improved survival. Although the overall benefit to risk ratio of osteoporosis medications remains favorable, there have been concerns raised about the long-term safety of these treatments. Atypical femur fracture, which is a rare type of fracture that has been associated with the long-term use of potent antiresorptive bone medications, is a potentially devastating consequence of osteoporosis treatment. This paper reviews our current understanding of atypical femur fractures, their relationship to antiresorptive osteoporosis medications, and proposed strategies for management, in order to inform clinical decision making about the optimal use and duration of medical therapy for the treatment of patients with osteoporosis or at high risk for osteoporotic fractures.

scholarly journals Opioid Analgesia: Perspectives on Right Use and Utility

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 479-491 ◽  
Author(s):  
Jane C. Ballantyne
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Side Effects ◽  
Clinical Decision Making ◽  
Analgesic Efficacy ◽  
Clinical Decision ◽  
Opioid Analgesia ◽  
Opioid Treatment

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the “principle of balance” may justify that “…efforts to address abuse should not interfere with legitimate medical practice and patient care.” Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients’ function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients’ rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of “producing good for the patient and protecting from harm,” so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. Key Words: Opioids, chronic pain, addiction, side effects, utility, ethics

scholarly journals Blood transfusion prescribing in the ACT: an insight into clinical decision making

2005 ◽  
Vol 29 (2) ◽  
pp. 240 ◽  
Author(s):  
Philip J Crispin ◽  
Bethany J Crowe ◽  
Anne M McDonald
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Early Discharge ◽  
Organisation Of Care ◽  
Metropolitan Hospital ◽  
Loss Of Appetite ◽  
Insight Into ◽  
Structured Questionnaire

This study aimed to determine the perspectives of a group of patients categorised as ?long-stay outliers? at a large South Australian metropolitan hospital about aspects of organisation of care and the perceived impact of long-term hospitalisation. Nineteen patients were interviewed using a semi-structured questionnaire. Eighty-nine percent of participants stated that they had no knowledge of how long they were to be in hospital. Forty-two percent indicated that they did not know when they would be discharged from hospital. This was of concern, especially considering the vulnerability of this patient group and the known benefits of patient involvement in decision making and the improvements this can make to health outcomes and early discharge. Participants indicated concern about sleep deprivation, diet, ability to return to paid employment, and missing their family as the main areas of impact of their long hospitalisation. Concerns about being discharged from hospital included: apprehension as to whether they were well enough to leave; the recurrence of infection; whether they would be able to sleep well when they got home; their recent loss of appetite and associated weight loss; mobility concerns; and what supports they would have when they were discharged home. All these issues require staff to be more patient and family-centred in their approach to preparing for discharge.

scholarly journals CLINICAL DECISION MAKING FOR THE HEMODYNAMIC GRAY ZONE (FFR 0.75-0.80) AND IMPACT ON LONG TERM OUTCOMES

2016 ◽  
Vol 67 (13) ◽  
pp. 379 ◽  
Author(s):  
Shiv Kumar Agarwal ◽  
Mohan Edupuganti ◽  
Ahmed Almomani ◽  
Naga Venkata Pothineni ◽  
Jason Payne ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Gray Zone ◽  
Long Term Outcomes

Home Telecare, Medical Implant, and Mobile Technology

2013 ◽  
pp. 222-237
Author(s):  
Vishaya Naidoo ◽  
Yedishtra Naidoo
Keyword(s):  
Mobile Technology ◽  
Long Term Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Technological Solution ◽  
Term Care ◽  
Mobile Wireless ◽  
Global Aging ◽  
Mobile Wireless Technology

With a rapidly expanding global aging population, alternatives must be developed to minimize the inevitable increase in acute and long-term care admissions to the health care system. This chapter explores the use of home telecare as an alternative medical approach to managing this growing trend, while also providing superior care to geriatric patients. To address some of the emergent disadvantages of home telecare concerning usability, self-management, and confinement to the home, the use of a cardiac implant in conjunction with a mobile device—to assist in the management of chronic heart failure in seniors—is proposed as a promising technological solution to overcoming these limitations. Ultimately, it seems that the growth of home telecare, as well as the great potential to enhance its services with the use of mobile wireless technology, stands to drastically improve clinical decision-making and management of health services in the future.

scholarly journals A164 UPTAKE OF FECAL CALPROTECTIN IN PRACTICE: PATTERNS IN A TERTIARY GI REFERRAL CENTRE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 28-30
Author(s):  
A Kundra ◽  
T Ritchie ◽  
M Ropeleski
Keyword(s):  
Medical Therapy ◽  
Bowel Disease ◽  
Large Scale ◽  
Clinical Decision Making ◽  
Practice Patterns ◽  
Clinical Decision ◽  
Fecal Calprotectin ◽  
Time Interval ◽  
Chart Audit ◽  
Frequency Pattern

Abstract Background Fecal Calprotectin (FC) is helpful in distinguishing functional from organic bowel disease. Also, it has proven useful in monitoring disease activity in inflammatory bowel disease (IBD). The uptake of its use in clinical practice has increased considerably, though access varies significantly. Studies exploring current practice patterns among GI specialists and how to optimize its use are limited. In 2017, Kingston Health Sciences Centre (KHSC) began funding FC testing at no cost to patients. Aims We aimed to better understand practice patterns of gastroenterologists in IBD patients where there is in house access to FC assays, and to generate hypotheses regarding its optimal use in IBD monitoring. We hypothesize that FC is not being used in a regular manner for monitoring of IBD patients. Methods A retrospective chart audit study was done on all KHSC patients who had FC testing completed from 2017–2018. Qualitative data was gathered from dictated reports using rigorous set definitions regarding indication for the test, change in clinical decision making, and frequency patterns of testing. Specifically, change in use for colonoscopy or in medical therapy was coded only if the dictated note was clear that a decision hinged largely on the FC result. Frequency of testing was based on test order date. Reactive testing was coded as tests ordered to confirm a clinical flare. Variable testing was coded where monitoring tests that varied in intervals greater than 3 months and crossed over the other set frequency codes. Quantitative data regarding FC test values, and dates were also collected. This data was then analyzed using descriptive statistics. Results Of the 834 patients in our study, 7 were under 18 years old and excluded. 562(67.34%) of these patients had a pre-existing diagnosis of IBD; 193 (34%) with Ulcerative Colitis (UC), 369 (66%) with Crohn’s Disease (CD). FC testing changed the clinician’s decision for medical therapy in 12.82% of cases and use for colonoscopy 13.06% of the time for all comers. Of the FC tests, 79.8% were sent in a variable frequency pattern and 2.68% with reactive intent. The remaining 17.5% were monitored with a regular pattern, with 8.57% patients having their FC monitored at regular intervals greater than 6 months, 7.68% every 6 months, and 1.25% less than 6 months. The average FC level of patients with UC was 356.2ug/ml and 330.6 ug/ml for CD. The mean time interval from 1st to 2nd test was 189.6 days. Conclusions FC testing changed clinical decisions regarding medical therapy and use for colonoscopy about 13% of the time. FC testing was done variably 79.8% of the time, where as 17.5% of patients had a regular FC monitoring schedule. An optimal monitoring interval for IBD flares using FC for maximal clinical benefit has yet to be determined. Large scale studies will be required to answer this question. Funding Agencies None

scholarly journals Current Role of Surgery in Pancreatic Cancer With Synchronous Liver Metastasis

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482097659
Author(s):  
Wentao Zhou ◽  
Dansong Wang ◽  
Wenhui Lou
Keyword(s):  
Pancreatic Cancer ◽  
Liver Metastasis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Synchronous Liver Metastasis ◽  
Long Term Outcomes ◽  
Short And Long Term ◽  
Current Guidelines

Pancreatic cancer with synchronous liver metastasis has an extremely poor prognosis, and surgery is not recommended for such patients by the current guidelines. However, an increasing body of studies have shown that concurrent resection of pancreatic cancer and liver metastasis is not only technically feasible but also beneficial to the survival in the selected patients. In this review, we aim to summarize the short- and long-term outcomes following synchronous liver metastasectomy for pancreatic cancer patients, and discuss the potential criteria in selecting appropriate surgical candidates, which might be helpful in clinical decision-making.

scholarly journals A Re-assessment of the Safety and Efficacy of Interleukin-2 for the Treatment of Renal Cell Carcinoma

2009 ◽  
Vol 1 ◽  
pp. CMT.S2037 ◽  
Author(s):  
Anthony Jarkowski ◽  
Michael K.K. Wong
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clinical Decision Making ◽  
Interleukin 2 ◽  
Clinical Decision ◽  
High Dose ◽  
Perceived Morbidity

Interleukin-2 (IL-2) can provide long term durable remissions for patients with advanced or metastatic renal cell carcinoma. The perceived morbidity and the difficulties in delivering this treatment hampered its widespread use in these patients. This review aims to place IL-2 in the modern milieu by reviewing the pharmacology, efficacy and toxicity of this drug. These will be contrasted and compared with the new targeted-agents. The methodology of providing high dose IL-2 treatment, follow-up care and its impact on patient quality of life will be discussed. Importantly, the ability of these agents to provide durable, complete remissions for RCC patients will be placed in context. The goal is to provide the perspective and framework for the reader to balance the important attributes of each of these drugs during the clinical decision making process.

Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making.

1997 ◽  
Vol 16 (4) ◽  
pp. 380-389 ◽  
Author(s):  
Abby C. King ◽  
Michaela Kiernan ◽  
Roy F. Oman ◽  
Helena C. Kraemer ◽  
Mary Hull ◽  
...  
Keyword(s):  
Physical Activity ◽  
Decision Making ◽  
Signal Detection ◽  
Clinical Decision Making ◽  
Clinical Decision

Treatment for Lexical Retrieval Impairments in Primary Progressive Aphasia: A Research Update with Implications for Clinical Practice

2018 ◽  
Vol 39 (03) ◽  
pp. 242-256 ◽  
Author(s):  
Karen Croot
Keyword(s):  
Clinical Practice ◽  
Clinical Decision Making ◽  
Primary Progressive Aphasia ◽  
Clinical Decision ◽  
Lexical Retrieval ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Behavioral Studies ◽  
Long Term Treatment

AbstractLexical retrieval impairments (also known as anomia or word-finding deficits) are an early and prominent symptom in primary progressive aphasia (PPA), causing distress and frustration to individuals with PPA and their communication partners, and prompting research on lexical retrieval treatment. This paper reviews the research on lexical retrieval treatment in PPA from the earliest reports in the 1990s to early 2018 and considers the implications of this research for clinical practice. The number of published studies has increased markedly over the past decade, consisting primarily of behavioral studies, with rapid recent growth in noninvasive brain stimulation studies. Five general treatment techniques were identified in the behavioral studies, described here as standard naming treatment, Look, Listen, Repeat treatment, cueing hierarchies, semantically focused treatments, and lexical retrieval in context. Across techniques, behavioral studies targeting difficult-to-retrieve items typically report immediate gains, and there is evidence these gains can be maintained over months to years by some participants who continue with long-term treatment. There is also evidence that prophylactic treatment supports retrieval of treated items compared with untreated items. There is limited evidence for generalization of treatment to untreated items, suggesting the primary aim of lexical retrieval treatment in this population is to maintain retrieval of a core vocabulary for as long as possible. Language and cognitive assessment and piloting of the intended treatment can inform decisions about treatment selection and participant suitability for long-term lexical retrieval treatment. The paper concludes with some questions to guide clinical decision making about whether to implement or continue with a behavioral lexical retrieval treatment.

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